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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Feb;74(2):163–169. doi: 10.1136/jnnp.74.2.163

The relative health related quality of life of veterans with Parkinson's disease

H Gage 1, A Hendricks 1, S Zhang 1, L Kazis 1
PMCID: PMC1738285  PMID: 12531940

Abstract

Objectives: To use databases of the US Veterans Health Administration (VHA) to describe the impact of Parkinson's disease on health related quality of life (HRQoL) of veterans; to compare the HRQoL of veterans with Parkinson's disease with that of veterans reporting eight other neurological or chronic conditions; and to estimate the unique effect of Parkinson's disease on HRQoL.

Methods: Respondents to the VHA 1999 large national health survey of veteran enrollees with a diagnosis of Parkinson's disease in VHA treatment files for the fiscal years 1997–1999 were identified by merging databases. The survey incorporated the Veterans SF-36, a well validated generic measure of HRQoL and functional status. This was used to compare patient groups. Mean physical (PCS) and mental (MCS) component summary scores were calculated for Parkinson's disease and eight other diseases by multivariable regressions that adjusted for age, sex, race, education, and 15 mental and physical co-morbid conditions that were self reported in the survey.

Results: Of 887 775 survey respondents, 14 530 (1.64%) had a Parkinson's disease diagnosis. Controlling for sociodemographic factors and co-morbidities, veterans with Parkinson's disease had PCS and MCS below veterans with angina/coronary heart disease, arthritis, chronic low back pain, congestive heart failure, diabetes, and stroke. Veterans with spinal cord injury reported slightly lower PCS than veterans with Parkinson's disease (32.38 v 32.72; 0.03 of 1 SD). Veterans with depression reported markedly lower MCS than veterans with Parkinson's disease (35.94 v 41.48; 0.55 of 1 SD). The unique effect of having Parkinson's disease on HRQoL was to lower PCS and MCS by 4.10 and 3.42 points (0.41 and 0.34 of 1 SD), respectively.

Conclusions: The analysis quantifies the negative impact of Parkinson's disease on HRQoL, after controlling for sociodemographic factors and co-morbidities. Compared with eight other chronic conditions, Parkinson's disease imposes a relatively heavy burden on US veterans in the VHA health care system.

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Selected References

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  1. Abudi S., Bar-Tal Y., Ziv L., Fish M. Parkinson's disease symptoms--patients' perceptions. J Adv Nurs. 1997 Jan;25(1):54–59. doi: 10.1046/j.1365-2648.1997.1997025054.x. [DOI] [PubMed] [Google Scholar]
  2. Addington-Hall J., Kalra L. Who should measure quality of life? BMJ. 2001 Jun 9;322(7299):1417–1420. doi: 10.1136/bmj.322.7299.1417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Albrecht G. L., Devlieger P. J. The disability paradox: high quality of life against all odds. Soc Sci Med. 1999 Apr;48(8):977–988. doi: 10.1016/s0277-9536(98)00411-0. [DOI] [PubMed] [Google Scholar]
  4. Carr A. J., Gibson B., Robinson P. G. Measuring quality of life: Is quality of life determined by expectations or experience? BMJ. 2001 May 19;322(7296):1240–1243. doi: 10.1136/bmj.322.7296.1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Carr A. J., Higginson I. J. Are quality of life measures patient centred? BMJ. 2001 Jun 2;322(7298):1357–1360. doi: 10.1136/bmj.322.7298.1357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chrischilles E. A., Rubenstein L. M., Voelker M. D., Wallace R. B., Rodnitzky R. L. The health burdens of Parkinson's disease. Mov Disord. 1998 May;13(3):406–413. doi: 10.1002/mds.870130306. [DOI] [PubMed] [Google Scholar]
  7. Cutson T. M., Laub K. C., Schenkman M. Pharmacological and nonpharmacological interventions in the treatment of Parkinson's disease. Phys Ther. 1995 May;75(5):363–373. doi: 10.1093/ptj/75.5.363. [DOI] [PubMed] [Google Scholar]
  8. Dakof G. A., Mendelsohn G. A. Parkinson's disease: the psychological aspects of a chronic illness. Psychol Bull. 1986 May;99(3):375–387. [PubMed] [Google Scholar]
  9. Dakof G. A., Mendelsohn G. A. Patterns of adaptation to Parkinson's disease. Health Psychol. 1989;8(3):355–372. doi: 10.1037//0278-6133.8.3.355. [DOI] [PubMed] [Google Scholar]
  10. Daltroy L. H., Larson M. G., Eaton H. M., Phillips C. B., Liang M. H. Discrepancies between self-reported and observed physical function in the elderly: the influence of response shift and other factors. Soc Sci Med. 1999 Jun;48(11):1549–1561. doi: 10.1016/s0277-9536(99)00048-9. [DOI] [PubMed] [Google Scholar]
  11. Damiano A. M., McGrath M. M., Willian M. K., Snyder C. F., LeWitt P. A., Reyes P. F., Richter R. R., Means E. D. Evaluation of a measurement strategy for Parkinson's disease: assessing patient health-related quality of life. Qual Life Res. 2000 Feb;9(1):87–100. doi: 10.1023/a:1008928321652. [DOI] [PubMed] [Google Scholar]
  12. Devinsky O. Outcome research in neurology: incorporating health-related quality of life. Ann Neurol. 1995 Feb;37(2):141–142. doi: 10.1002/ana.410370202. [DOI] [PubMed] [Google Scholar]
  13. Deyo R. A. The quality of life, research, and care. Ann Intern Med. 1991 Apr 15;114(8):695–697. doi: 10.7326/0003-4819-114-8-695. [DOI] [PubMed] [Google Scholar]
  14. Ehmann T. S., Beninger R. J., Gawel M. J., Riopelle R. J. Coping, social support, and depressive symptoms in Parkinson's disease. J Geriatr Psychiatry Neurol. 1990 Apr-Jun;3(2):85–90. doi: 10.1177/089198879000300206. [DOI] [PubMed] [Google Scholar]
  15. Ellgring H., Seiler S., Perleth B., Frings W., Gasser T., Oertel W. Psychosocial aspects of Parkinson's disease. Neurology. 1993 Dec;43(12 Suppl 6):S41–S44. [PubMed] [Google Scholar]
  16. Fukunaga H., Kasai T., Yoshidome H. Clinical findings, status of care, comprehensive quality of life, daily life therapy and treatment at home in patients with Parkinson's disease. Eur Neurol. 1997;38 (Suppl 2):64–69. doi: 10.1159/000113494. [DOI] [PubMed] [Google Scholar]
  17. Gotham A. M., Brown R. G., Marsden C. D. Depression in Parkinson's disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry. 1986 Apr;49(4):381–389. doi: 10.1136/jnnp.49.4.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Idler E. L., Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997 Mar;38(1):21–37. [PubMed] [Google Scholar]
  19. Karlsen K. H., Larsen J. P., Tandberg E., Maeland J. G. Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 1999 Apr;66(4):431–435. doi: 10.1136/jnnp.66.4.431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kazis L. E., Miller D. R., Clark J., Skinner K., Lee A., Rogers W., Spiro A., 3rd, Payne S., Fincke G., Selim A. Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. Arch Intern Med. 1998 Mar 23;158(6):626–632. doi: 10.1001/archinte.158.6.626. [DOI] [PubMed] [Google Scholar]
  21. Kazis L. E., Ren X. S., Lee A., Skinner K., Rogers W., Clark J., Miller D. R. Health status in VA patients: results from the Veterans Health Study. Am J Med Qual. 1999 Jan-Feb;14(1):28–38. doi: 10.1177/106286069901400105. [DOI] [PubMed] [Google Scholar]
  22. Koch T. Life quality vs the 'quality of life': assumptions underlying prospective quality of life instruments in health care planning. Soc Sci Med. 2000 Aug;51(3):419–427. doi: 10.1016/s0277-9536(99)00474-8. [DOI] [PubMed] [Google Scholar]
  23. Kuopio A. M., Marttila R. J., Helenius H., Toivonen M., Rinne U. K. The quality of life in Parkinson's disease. Mov Disord. 2000 Mar;15(2):216–223. doi: 10.1002/1531-8257(200003)15:2<216::aid-mds1003>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  24. Lieberman A. An integrated approach to patient management in Parkinson's disease. Neurol Clin. 1992 May;10(2):553–565. [PubMed] [Google Scholar]
  25. MacCarthy B., Brown R. Psychosocial factors in Parkinson's disease. Br J Clin Psychol. 1989 Feb;28(Pt 1):41–52. doi: 10.1111/j.2044-8260.1989.tb00810.x. [DOI] [PubMed] [Google Scholar]
  26. Martínez-Martín P. An introduction to the concept of "quality of life in Parkinson's disease". J Neurol. 1998 May;245 (Suppl 1):S2–S6. doi: 10.1007/pl00007733. [DOI] [PubMed] [Google Scholar]
  27. McHorney C. A., Ware J. E., Jr, Lu J. F., Sherbourne C. D. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994 Jan;32(1):40–66. doi: 10.1097/00005650-199401000-00004. [DOI] [PubMed] [Google Scholar]
  28. McHorney C. A., Ware J. E., Jr, Raczek A. E. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993 Mar;31(3):247–263. doi: 10.1097/00005650-199303000-00006. [DOI] [PubMed] [Google Scholar]
  29. Meyers A. R., Gage H., Hendricks A. Health-related quality of life in neurology. Arch Neurol. 2000 Aug;57(8):1224–1227. doi: 10.1001/archneur.57.8.1224. [DOI] [PubMed] [Google Scholar]
  30. Nordeson A., Engström B., Norberg A. Self-reported quality of life for patients with progressive neurological diseases. Qual Life Res. 1998 Apr;7(3):257–266. doi: 10.1023/a:1024950417332. [DOI] [PubMed] [Google Scholar]
  31. Pearlman R. A., Uhlmann R. F. Quality of life in chronic diseases: perceptions of elderly patients. J Gerontol. 1988 Mar;43(2):M25–M30. doi: 10.1093/geronj/43.2.m25. [DOI] [PubMed] [Google Scholar]
  32. Pentland B., Barnes M. P., Findley L. J., Oxtoby M., Pearce V. R., Quinn N. P., Scott S. Parkinson's disease: the spectrum of disabilities. J Neurol Neurosurg Psychiatry. 1992 Mar;55 (Suppl):32–35. doi: 10.1136/jnnp.55.suppl.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Phillips P. Keeping depression at bay helps patients with Parkinson disease. JAMA. 1999 Sep 22;282(12):1118–1119. [PubMed] [Google Scholar]
  34. Rubenstein L. M., DeLeo A., Chrischilles E. A. Economic and health-related quality of life considerations of new therapies in Parkinson's disease. Pharmacoeconomics. 2001;19(7):729–752. doi: 10.2165/00019053-200119070-00003. [DOI] [PubMed] [Google Scholar]
  35. Rubenstein L. M., Voelker M. D., Chrischilles E. A., Glenn D. C., Wallace R. B., Rodnitzky R. L. The usefulness of the Functional Status Questionnaire and Medical Outcomes Study Short Form in Parkinson's disease research. Qual Life Res. 1998 May;7(4):279–290. doi: 10.1023/a:1024973611880. [DOI] [PubMed] [Google Scholar]
  36. Schapira A. H. Science, medicine, and the future: Parkinson's disease. BMJ. 1999 Jan 30;318(7179):311–314. doi: 10.1136/bmj.318.7179.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Scheife R. T., Schumock G. T., Burstein A., Gottwald M. D., Luer M. S. Impact of Parkinson's disease and its pharmacologic treatment on quality of life and economic outcomes. Am J Health Syst Pharm. 2000 May 15;57(10):953–962. doi: 10.1093/ajhp/57.10.953. [DOI] [PubMed] [Google Scholar]
  38. Schrag A., Jahanshahi M., Quinn N. What contributes to quality of life in patients with Parkinson's disease? J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):308–312. doi: 10.1136/jnnp.69.3.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Sprangers M. A., Schwartz C. E. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med. 1999 Jun;48(11):1507–1515. doi: 10.1016/s0277-9536(99)00045-3. [DOI] [PubMed] [Google Scholar]
  40. Ware J. E., Jr, Bayliss M. S., Rogers W. H., Kosinski M., Tarlov A. R. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA. 1996 Oct 2;276(13):1039–1047. [PubMed] [Google Scholar]
  41. Ware J. E., Jr, Kosinski M., Bayliss M. S., McHorney C. A., Rogers W. H., Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995 Apr;33(4 Suppl):AS264–AS279. [PubMed] [Google Scholar]
  42. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]

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